Directia Generala de Asistenta Sociala si Protectia Copilului Vaslui

Complexul de Servicii Comunitare pentru Copilul cu Handicap Vaslui

FI DE EVALUARE PSIHOLOGIC

Numele i prenumele ______________________________________________________

Data naterii _____________________________________________________________
coala/Grdinia __________________________________________________________
Diagnostic ______________________________________________________________
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I. Date despre familie
1. Numele i prenumele/data naterii:
Mama __________________________________________________________________
Tata ___________________________________________________________________
2. Loc de munc:
Mama __________________________________________________________________
Tata ___________________________________________________________________

3. Componena familiei ________________________________________________

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4. Condiii materiale i de locuit _________________________________________
5. Climat i relaii familiale _____________________________________________
II. Date medicale
Sarcina _________________________________________________________________
Naterea ________________________________________________________________
Antecedente patologice ale copilului __________________________________________
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Antecedende patologice ale membrilor familiei__________________________________
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 III. E valuarea psihologica
1. Procese cognitiv senzoriale
a. perceptii vazul________________________________________________________
auzul ________________________________________________________
tactul _______________________________________________________
olfactul ______________________________________________________
gustativ______________________________________________________
proprioceptia ______________________________________________________
kinestezia _________________________________________________________
formei ____________________________________________________________
marimii ___________________________________________________________
spaiului __________________________________________________________
micrii ___________________________________________________________
vedere tridimensional _______________________________________________
- poziia sus-jos ________________________________________________
- poziia dreapta-stnga _________________________________________
- poziia fa-spate _____________________________________________
b. reprezentri
vizuale ___________________________________________________________
auditive ___________________________________________________________
reproductive _______________________________________________________
anticipative ________________________________________________________

2. Procese cognitive logice

a. gndirea
Inteligena senzoriomotorie ___________________________________________
Reacia de orientare _________________________________________________
Reacia de investigaie _______________________________________________
Reacii circulare primare (1-5 luni) _____________________________________
Reacii circulare secundare ___________________________________________
Percepia succesiunii ________________________________________________
Orientarea aciunii dup criterii de eficien ______________________________

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 Comportament de cutare ____________________________________________
Prezena scopului n aciune ___________________________________________
Prezena comportamentului anticipativ __________________________________
Interiorizarea aciunii ________________________________________________
Prezena aciunilor simbolice __________________________________________
Apariia posibilitilor de schematizare (desen) ___________________________
Prezena operaiilor de scriere _________________________________________
Prezena operaiilor de clasificare ______________________________________
Reversibilitatea, invariaia, identificarea _________________________________
Prezena conceptelor i conceptelor superioare ____________________________
Reversibilitatea prin inversiune (adunare, scdere) _________________________
Reciprocitatea _____________________________________________________
Operaii de calcul ___________________________________________________
Stabilirea de relaii ntre obiecte _______________________________________
Prezena judecilor de valoare ________________________________________
Prezena noiunilor abstracte, integratorii, categoriale ______________________
Prezena operaiilor gndirii ___________________________________________
Inteligena (QI) _____________________________________________________
b. Limbaj i comunicare
Modaliti de stabilire a contactului (mimic, gestic, sunete) ________________
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Existena unor sunete funcionale ______________________________________
Lalaia (vocale, consoane, imitaii) _____________________________________
Cuvinte (cu sau fr sens) ____________________________________________
nelege sensul cuvintelor, situaiilor, persoanelor, etc ______________________
Prezena limbajului gestual ___________________________________________
Propoziii scurte simple ______________________________________________
Interiorizarea limbajului ______________________________________________
Propoziii, fraze (cum ?) _____________________________________________
Ecolalii ___________________________________________________________
Deficiene de vorbire ________________________________________________
Deficiene de articulare ______________________________________________
Deficiene de voce __________________________________________________
Deficiene de ritm __________________________________________________

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 Dislexo-disgrafie ___________________________________________________
Discalculie ________________________________________________________
Lateralitate ________________________________________________________
Vocabular _________________________________________________________
Intensitatea vocii ___________________________________________________
Intonaie __________________________________________________________
c. Memoria
Memorarea intenionat (logic, mecanic) neintenionat ___________________
Reactualizare (reproducere, recunoatere) ________________________________
Fidelitatea reactualizrii ______________________________________________
Mijloace mnemotehnice ______________________________________________
Memorie de lung/scurt durat ________________________________________
Volumul memoriei __________________________________________________
Trinicia pstrrii ___________________________________________________
Promptitudinea reactualizrii __________________________________________
d. Imaginaia
Reproductiv ______________________________________________________
Creatoare _________________________________________________________
Desenul (dup model, dup reprezentare) ________________________________

3. Procese reglatorii
a) Motivaia
Extern sau intern __________________________________________________
Cognitiv sau afectiv _______________________________________________
Aprecierea gradului de dificultate al sarcinii ______________________________
b) Afectivitate
Contactul afectiv (emoia, mimica, intensitatea sunetelor, modificri
psihofiziologice, pantomimica) ________________________________________
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Prezena emoiilor (prezena, n ce fel) __________________________________
Dispoziie _________________________________________________________
Sentimente ________________________________________________________
Pasiuni, vicii _______________________________________________________
Hobby-uri _________________________________________________________

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c) Voina
Prezena autoreglajului n activiti _____________________________________
Prezena scopului ___________________________________________________
Prezena efortului voluntar (intensitate, perseveren, ncpnare, independen,
promptitudinea deciziilor) ____________________________________________
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d) Atenia
Frecvena strii de veghe fa de starea de somn ___________________________
Reacia la stimuli (involuntar) ________________________________________
Capacitatea de concentrare ___________________________________________
Stabilitatea ateniei __________________________________________________
Distributivitatea ateniei ______________________________________________
Flexibilitatea ateniei ________________________________________________

4. Comportament
Calm, linitit foarte activ ____________________________________________
Timid adeziv _____________________________________________________
Pasiv activ _______________________________________________________
Gelozie fa de alte persoane __________________________________________
Socializare ________________________________________________________
Comportament de aprare mpotriva pericolelor ___________________________
Anxietate _________________________________________________________
Agresivitate (context) ________________________________________________
Autostimulare (context) ______________________________________________
Contact social ______________________________________________________

5. Activitati
a) Jocul
Privete jucria _____________________________________________________
Apuc jucria ______________________________________________________
Duce jucria la gura _________________________________________________
Caut jucria ______________________________________________________
Jocuri preferate (educative, simbolice etc) _______________________________

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 Jocul cu adulii _____________________________________________________
Jocul n grup _______________________________________________________
Obiect preferat pentru joc ____________________________________________
b) Invatarea
Volum de cunotine ________________________________________________
Capacitate de nelegere ______________________________________________
Integrarea jocului cu nvarea _________________________________________
Se bazeaz pe memorie, gndire etc ____________________________________
Activiti pentru care are aptitudini _____________________________________
Deprinderi ________________________________________________________

6. Contiina
Percepia de sine ___________________________________________________
Imaginea de sine ___________________________________________________
Diferenierea Eu non Eu ____________________________________________

7. Personalitatea
Tip de temperament _________________________________________________
Rol n familie / grup _________________________________________________
Statut n familie / grup _______________________________________________

8. Concluzii, observaii, recomandri

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Data evalurii, Evaluator,